- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Enrollment open, Trial completion date, Trial primary completion date: EXtending the Time Window for Thrombolysis in Posterior Circulation Stroke Without Early CT Signs (clinicaltrials.gov) - Feb 8, 2023
P3, N=233, Recruiting,
The results of this study showed that thrombolytic therapy reduced the intensity of anxiety and depression and improves the quality of life of patients six months after ischemic stroke. Not yet recruiting --> Recruiting | Trial completion date: Aug 2023 --> Aug 2024 | Trial primary completion date: May 2023 --> May 2024
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Antiplatelet Versus Alteplase In Acute Mild Ischaemic Stroke (ARAMIS): A Multicentre, Open-label, Blinded-endpoint, Randomised, Controlled, Noninferiority Trial (Hall E) - Feb 7, 2023 - Abstract #ISC2023ISC_1937;
Due to the wide confidence intervals, larger randomized trials comparing low- and standard-dose alteplase bridging therapy are required. Available on Friday, February 10, 2023 at 12:17pm CST.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
The FLAIR Signal Intensity Ratio Predicts Early Neurologic Deterioration For Small Subcortical Infarcts (Hall F, Poster Hall; P194) - Feb 7, 2023 - Abstract #ISC2023ISC_1732;
The fluid-attenuated inversion recovery signal intensity ratio (FLAIR-SIR) ≥ 1.15 was shown to aid in differentiation of completed infarcts from those with penumbra allowing in identifying those that may benefit from alteplase...Our findings corroborate prior studies identifying 1.15 as a threshold for at-risk and completed SSI and should receive thrombolytics to minimize risk of END. Future studies are needed to increase power and confirm our findings.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Intravenous Thrombolysis In Combination With Mechanical Thrombectomy: An Updated Meta-Analysis Of Clinical Trials (Hall F, Poster Hall; P142) - Feb 7, 2023 - Abstract #ISC2023ISC_1649;
Our results did not favor either IVT+MT or MT alone in terms of clinical outcomes and complications. However, more trials are needed to further compare both approaches and to evaluate the impact of certain factors on this comparison such as MT technique (Stent Retriever versus Aspiration), LVO location, and the used thrombolytic agent (Alteplase versus Tenecteplase).
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
The Effect Of Aortic Arch And Carotid Artery Anatomy Parameters On Door-To-Recanalization Times At A Comprehensive Stroke Center (Hall F, Poster Hall; P134) - Feb 7, 2023 - Abstract #ISC2023ISC_1642;
A binary logistic regression analysis was performed, controlling for age, gender, presenting mean arterial pressure (MAP), presenting serum glucose, Hb A1C, LDL, intravenous alteplase, left hemispheric location, location of occlusion [proximal (ICA or M1 segment of the middle cerebral artery) versus distal (M2 segment of the middle cerebral artery)], ASPECTS≥6, general anesthesia, transradial approach, number of passes... Among aortic arch and carotid artery anatomy parameters, the presence of a bovine arch was associated with significantly delayed DTRp of >120 minutes in our cohort
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Hemorrhagic Transformation After Endovascular Thrombectomy Is Associated With Basal Ganglia Infarct Volume (Hall F, Poster Hall; P128) - Feb 7, 2023 - Abstract #ISC2023ISC_1635;
Greater basal ganglia infarct volume was associated with a higher risk of HT when accounting for infarct volumes in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery perforator occlusion.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim
The Utilization Of Tenecteplase In Reducing Door-to Needle Time In Ischemic Stroke Patients (Hall F, Poster Hall; P7) - Feb 7, 2023 - Abstract #ISC2023ISC_1517;
For the first 6 months of tenecteplase implementation the DTN time increased at FSEDs and PSCs but remained unchanged in higher volume centers. In conclusion, switching from alteplase to tenecteplase for the treatment of acute ischemic stroke significantly reduced DTN time in our ED without increasing ICH.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
A Novel Microfluidic Model Of Ischemic Stroke Recapitulating Arterial Occlusion And Prolonged Retraction (Hall F, Poster Hall; MP116) - Feb 7, 2023 - Abstract #ISC2023ISC_1499;
Sample from the same donor dosed with 0.7 or 7nM alteplase (ALT) was perfused using the Y inlet using a constant pressure head (1000/s; mimicking middle cerebral artery) for 120 min.|After 6 hours of post-occlusion retraction, thrombi substantially remodeled...Reperfusion after 6 hrs resulted in a reduction of 14% (14%) with 0.7nM, 45% (12%) with 7nM, and 17% (8%) with vehicle.|We have established an ex vivo high throughput system capable of recapitulating arterial occlusion, thrombus retraction in situ, drug delivery, and thrombolysis. This system can be used for mechanistic inquiry and drug discovery.|
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Current State Of Acute Stroke Thrombolysis In The MT2020+ Caribbean Region (Hall F, Poster Hall; MP48) - Feb 7, 2023 - Abstract #ISC2023ISC_1421;
This this survey brings light to an enormous disparity in care of stroke patients around the world, specifically in the MT2020+ Caribbean region. We create a valid tool can be used to assess local access to thrombolytic.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Tenecteplase Versus Alteplase In Acute Ischaemic Cerebrovascular Events (trace-2): A Phase 3, A Multi-centre, Open-label, Randomised Controlled, Non-inferiority Trial (Hall E) - Feb 7, 2023 - Abstract #ISC2023ISC_1161;
We create a valid tool can be used to assess local access to thrombolytic. Available on Thursday, February 09, 2023 at 12:18pm CST.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Transition To Tenecteplase From Alteplase Improves Ambulance And Interfacility Transfer Time Metrics In A Large Regional Healthcare System (Room D163 / D165 / D170 / D172; In Person) - Feb 7, 2023 - Abstract #ISC2023ISC_1028;
58.5% of the TNK cases had a DIDO of ≤ 90 minutes vs 34.4% of tPA cases.|Conclusions Switching from IV-tPA to IV-TNK improved the DIDO by 33 minutes. This improvement was driven by two novel DIDO metrics: Door to Ambulance Arrival Time (DAA) and Ambulance Arrival to Ambulance Departure Time (AAAD) likely because the absence of a tPA infusion (drip & ship) allowed the use of non-critical care ambulances, which are more widely available, to transport patients.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Comparable Safety And Efficacy Profiles For Tenecteplase And Alteplase In Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke (Hall F, Poster Hall; LBP1) - Feb 7, 2023 - Abstract #ISC2023ISC_839;
Available on Wednesday, February 08, 2023 at 08:00am CST. Available on Wednesday, February 08, 2023 at 08:00am CST.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Long-Term Spontaneous Recanalization Rates Of Symptomatic Cervical Carotid Artery Occlusions (Hall F, Poster Hall; P134) - Feb 7, 2023 - Abstract #ISC2023ISC_831;
Cervical ICAO recanalization occurred in 12 (22%) patients in our cohort at follow-up and allowed for carotid revascularization procedures in 3 (25%) of these patients. Outpatient follow-up cervical vessel imaging should be considered after symptomatic cervical ICAO, as identifying spontaneous recanalization can alter management.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Driving Down Door To Needle Time: ED Stroke Leadership's Commitment To Continuous Improvement (Hall F, Poster Hall; P31) - Feb 7, 2023 - Abstract #ISC2023ISC_727;
In addition to changing the IV thrombolytic from alteplase to tenecteplase, the team took the opportunity to make additional changes to the process and provided education of the stroke protocols and measures to the staff. In conclusion, the ED Stroke Leadership Team’s commitment to continuous improvement has been the driving factor in the reduction of the EMS Door to Needle time.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Benefit Of Alteplase And Lacunar Stroke: A Post-hoc Analysis Of The Shine Trial (Hall F, Poster Hall; P2) - Feb 7, 2023 - Abstract #ISC2023ISC_702;
Despite these differences, our findings support the use of acute thrombolytic therapy within this patient population. Future studies are needed to assess the response between small subcortical infarcts subtypes (e.g. branch atheromatous disease, subcortical microembolism, lipohyalinosis) and acute reperfusion therapy.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Outcomes Associated With Iv Tenecteplase And Iv Alteplase For Acute Ischemic Stroke With Or Without Thrombectomy In Real-world Settings In The United States (Hall F, Poster Hall; P11) - Feb 7, 2023 - Abstract #ISC2023ISC_697;
Future studies are needed to assess the response between small subcortical infarcts subtypes (e.g. branch atheromatous disease, subcortical microembolism, lipohyalinosis) and acute reperfusion therapy. In an analysis of real-world data, IV TNK was associated with higher rates of intracranial hemorrhage compared with IV alteplase in patients with acute ischemic stroke.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Health-related Quality Of Life After Thrombolysis In Acute Stroke: Results From The Act Trial (Hall F, Poster Hall; MP11) - Feb 7, 2023 - Abstract #ISC2023ISC_573;
There is no differential effect of the type of thrombolysis on patient-reported global HRQOL and health state utilities of acute stroke patients. Disparities in HRQOL were mainly explained by sex, age, and disease severity.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Tenecteplase Versus Alteplase For Acute Ischemic Stroke: Treatment Outcomes From A Large Northwest Us Stroke Registry (Hall F, Poster Hall; MP8) - Feb 7, 2023 - Abstract #ISC2023ISC_570;
In our study there were no differences in benefit, risk, or treatment logistics between alteplase and tenecteplase when used in treating acute ischemic stroke. Recanalization of large vessel occlusion prior to endovascular thrombectomy was not analyzed but will be the subject of study in this cohort.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Bridging Thrombolysis In Stroke Patients With Low Aspects Prior To Endovascular Thrombectomy (Hall F, Poster Hall; MP4) - Feb 7, 2023 - Abstract #ISC2023ISC_566;
In anterior circulation patients treated with EVT, bridging thrombolysis was associated with a higher probability of functional independence in those with more extensive early ischemia as determined by ASPECTS. These results suggest patients with large ischemic cores may still benefit from bridging thrombolysis, but this will need to be evaluated in further studies.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
A Five-minute Delay From Bolus Injection To Infusion Halves Plasma Concentration Of Tissue Plasminogen Activator (Hall F, Poster Hall; MP3) - Feb 7, 2023 - Abstract #ISC2023ISC_565;
These results suggest patients with large ischemic cores may still benefit from bridging thrombolysis, but this will need to be evaluated in further studies. Because of the short half-life of alteplase, even a short delay in initiating postbolus infusion can cause a significant reduction in the serum alteplase concentration.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Safety And Outcomes Of Endovascular Thrombectomy In Acute Ischemic Stroke Patients With Recent Use Of Non-vitamin K Antagonist Oral Anticoagulants (Ballroom C1 / C2; In Person) - Feb 7, 2023 - Abstract #ISC2023ISC_321;
After adjusting for baseline clinical factors including intravenous alteplase, patients taking NOACs were not at a significantly higher risk of sICH compared with patients not taking anticoagulants (4.9% vs 6.4%; aOR, 0.93 [95% CI, 0.75-1.14]) or in-hospital mortality (14.1% vs 13.1%; aOR, 0.90 [95% CI, 0.78-1.02])... Among patients with acute ischemic stroke treated with EVT within 6 hours, use of NOACs within the preceding 7 days, compared with no use of anticoagulants, was not associated with a significantly increased risk of adverse events and was associated with better functional outcomes at discharge.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Are You Ready For Your Pediatric Stroke Patient? (Room C140 / C142; In Person) - Feb 7, 2023 - Abstract #ISC2023ISC_184;
The team identified parameters and treatment for hypertension, angioedema and hemorrhagic conversion included in the newly developed pediatric stroke order set and Alaris pump build. Finally, a family centered brochure explaining the treatment for stroke along with directions to the Children’s Hospital completed this phase.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Review, Journal: Replacing Alteplase with Tenecteplase: Is the Time Ripe? (Pubmed Central) - Feb 7, 2023
In this review, we will focus on these recent advances, aiming: (1) to provide a brief overview of thrombolysis in stroke; (2) to provide comparisons between alteplase and TNK for clinical, imaging, and safety outcomes; (3) to focus on key subgroups of interest to understand if there is an advantage of using TNK over alteplase or vice-versa, to review available evidence on role of TNK in intra-arterial thrombolysis, as bridging therapy and in mobile stroke units; and (4) to summarize what to expect in the near future from recently completed trials and propose areas for future research on this evolving topic. We present compelling data from several trials regarding the safety and efficacy of TNK in acute ischemic stroke along with completed yet unpublished trials that will help provide insight into these unanswered questions.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Trial completion date, Trial primary completion date: 24 Hours Treatment With Alteplase in Patients With Ischemic Stroke (clinicaltrials.gov) - Feb 6, 2023
P3, N=372, Recruiting,
We present compelling data from several trials regarding the safety and efficacy of TNK in acute ischemic stroke along with completed yet unpublished trials that will help provide insight into these unanswered questions. Trial completion date: Dec 2023 --> Dec 2025 | Trial primary completion date: May 2023 --> May 2025
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Retrospective data, Review, Journal: Mechanical thrombectomy alone versus with thrombolysis for ischemic stroke: A meta-analysis of randomized trials. (Pubmed Central) - Feb 4, 2023
In this meta-analysis of six RCTs, MT alone was comparable to MT plus IVT for mRS 0-2, sICH, mortality, and distal embolization; however, MT alone resulted in lower rates of TICI 2b-3. Further trials are needed to determine which patient populations benefit from MT plus IVT and to increase the power of future meta-analyses.
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